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The Antibiotics Lowdown

Whether your child gets an earache, a sinus infection, or strep throat, antibiotics might be the best treatment. But these wonder drugs aren't doing the job they did ten years ago. For such common conditions as ear infections, doctors often have to double the dose (increasing the risk of side effects) or order a second type that's more powerful but sometimes harder to tolerate. How did we get to this point?

"Bad bacteria have figured out how to outsmart and outmuscle antibiotics," says Richard Besser, M.D., former medical director of the Centers for Disease Control and Prevention's antibiotics education program. Unfortunately, in most cases antibiotic resistance isn't slowing down  -- and there are no major antibiotics on the near horizon.

Children are on the front lines of this battle. They're more likely to be prescribed antibiotics  -- and to encounter drug-resistant bacteria  -- than adults. The effects can be quite direct: If your child develops an infection a few weeks or months after following a course of antibiotics, the chances of its being a resistant type is higher than if he hadn't taken them.

So, many doctors are taking a new tack. By limiting prescriptions to when they're really needed, they believe, resistant strains will disappear over time. But they need you: Pediatricians prescribe antibiotics 65 percent of the time if they think parents expect them, but only 12 percent if they feel parents don't, studies show.

So when can antibiotics really help your child? The best way to treat  -- and prevent  -- four potentially serious illnesses.

Maureen Connolly is coauthor of The Essential C-Section Guide.

Ear infection

Of the 10 million antibiotic prescriptions written to treat children's ear infections each year in the United States, two-thirds may be unnecessary. That's because 80 percent of the time, acute otitis media  -- an infection of the middle ear, the most common kind in young kids  -- will clear up on its own in a few days, and because children are often misdiagnosed.

In many cases it's best to wait and manage the discomfort with acetaminophen, pain-numbing drops (which your doctor may prescribe), and mild heat on the ear (try a warm, moist washcloth).

Watch out for:

  • Symptoms that don't subside within 48 hours
  • recurrent ear infections
  • severe pain, no appetite, or a marked reduction in activity
  • exposure to secondhand smoke
  • a child in daycare (kids are more susceptible to colds and flu, which can lead to ear infections)

If your child has any of these  -- or if he's under 2  -- the doctor may need to prescribe antibiotics.

prevention: The Prevnar vaccine, which protects against bacterial meningitis, also guards against seven strains of ear infection-causing bacteria. (Babies typically get four shots, between 2 and 15 months.) Since the year 2000, when the vaccine was recommended for all infants, the rates of ear infections have dropped 7 percent.

Staph infection

It starts with a simple cut or scrape and develops into painful, pus-filled sores. Staph infections are increasingly resistant. In most cases, kids can take oral antibiotics at home, but more and more are winding up in hospitals to get stronger ones intravenously.

Watch out for:
A cut or scrape that becomes increasingly red, is warm to the touch, larger than a quarter, or covered with pus  -- all signs of infection. The potential for staph infection is greater from wounds on the face, neck, hands, and feet. Ask the doctor to look at it; he may culture the area to see if it's staph and whether it's resistant to standard antibiotics.

prevention: Good hygiene. Rinse away debris or dirt from any wound with running water, then thoroughly cleanse the area with soap and water, pat it dry with a clean cloth, and cover it. Check the area once a day.

Strep and sinusitis

The good news: The strep bacteria isn't becoming resistant, because doctors wait until a strep test comes back positive before prescribing antibiotics. (Most sore throats are caused by viruses, which the drugs don't kill.)

Watch out for:
Severe throat pain  -- often with a headache and fever  -- but symptoms vary, so get any sore throat checked out by your doctor. Untreated, even mild cases can hurt the heart.

prevention: Since strep is contagious, regular hand washing with soap and water for 20 seconds is key.

Colds and the flu (both viral) don't respond to antibiotics. But sometimes a lingering cold may be sinusitis, a bacterial infection of the facial cavities.

Watch out for:
Thick, persistent nasal discharge; high fever; nighttime cough; headache. If symptoms linger for ten days, see the doctor, who may advise decongestants, fluids, and rest before antibiotics.

prevention: The fewer colds a child gets, the less likely he is to get sinusitis. Did we mention hand washing?